Fertiliser issue and CKDu prevalence: Pragmatism is the need of the hour

There is a need to review the current prevalence of Chronic Kidney Disease of Unknown Origin (CKDu) in the North Central Province (NCP), North Western Province (NWP) and Uva Province. It’s important to know the progression of this disorder in these provinces, as several decisions made recently (April-May ’21) based on the premise that the use of agrochemicals is responsible for CKDu have had both wide-ranging consequences on the food security of the country and its economy.

There has been much debate but as yet, no definite evidence can be adduced. The cause of CKDu remains unknown as yet. To those interested, an online source from an ‘authentic’ expert is available at DOI: http://doi. org/10.4038/jccp.v51i2.7900

The question whether CKDu is as prevalent now as it was when it was first noticed in patients from Padaviya in the early ’90s needs to be answered. As the origins were assumed to be related to consumption of water from deep wells, most households adopted rain-water harvesting at first, followed by installing a RO Unit (reverse osmosis) at home if they could afford one (at Rs 17,000). Or they obtained their water from such (large-RO) units (stations) established by the Army and Navy and community-based organisations in these areas. The Navy engineers, I gather are even making low cost membranes for RO units, which need annual replacement, an act which must be appreciated.

RO water is on sale in these areas; 20 litre bottles are priced at present at Rs 60-120. Bowser supply of potable water is another resource. The awareness of the general public living in NCP, NWP and UVA of CKDu and its possible ‘source’ of deep well water, is quite considerable. With these alternative water resources to most families in affected areas, except the remotest, now almost a decade or more later, one asks what is the prevalence of CKDu now?

From what I gather from those conducting medical clinics in these areas (including hospitals in these areas),the prevalence has dramatically regressed. The cases they see are mostly those affected in the decade earlier. Strangely however screening for CKDu, has been on the decline (a difficult task, as assays of renal tubular proteins - a pathognomic criterion for early diagnosis, are expensive). Since theMinistry of Health has a research unit related to CKDu,it would be mandatory for the Ministry to inform the public of the number of new cases per year and the statistics year on year, in the affected provinces for the last two decades.This will enable us to assess the magnitude of the problem and the results achieved with the current strategies of negation, now adopted.

This is necessary before a pragmatic national policy decisioncan be made at the highest levels; as a balanced decision is crucial.

If this is true-- i.e. regression of CKDu, banning agro-chemicals (including chemical fertilizer, weedicides such as glyphosate etc) seems to be a ‘hara-kiri’ over-reaction. The population of this country was 8 million at independence and has now grown to 21+million, and life expectancy which was around 50 years then, is now close upon 77 years. We imported rice in the 50’s but till this fiasco we were self- sufficient despite our population more than doubling and living longer.

Cultivators are currently used to high yields. There is an obvious need to prevent overuse of chemical fertilizer and to achieve some sort of balance with its organic counterpart in the long run. This will entail field trials to get the best admixture that is cost effective with respect to yields. Without educating cultivators on the need ensure soil health of their land vis-a-vis their yields and take a balanced view on the issue, to ban chemical fertilizer (without substantial evidence as to its deleterious effects on health) is unacceptable.

To ban it suddenly without a properly thought-out plan, is downright disastrous. I am sure the average educated citizen of this country expects a modicum of consultative wisdom from our leaders.

Dr Channa Ratnatunga

Kandy